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General Medicine > Gynae / GUM > Flashcards

Gynae / GUM Flashcards

1
Q

Symptoms of candidal vulvovaginitis

A

Soreness
Itching
Red skin - possible peeling, pustules or papules
White discharge

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2
Q

When to refer candidal vulvovaginitis

A

Unclear diagnosis
No improvement despite tx
Immunocompromised patient
Systemic tx needed

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3
Q

Tx of candidal vulvovaginitis

A

first line = Fluconazole capsule 150mg, single dose, orally

If oral treatment unsuitable / CI
Clotrimazole pessary 500mg STAT PV

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4
Q

Which COCP may also help with acne

A

Dianette - shouldn’t be used only for contraception

Yasmin

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5
Q

What syndrome is caused by 45XO

A

Turners syndrome - absence of one X chromosome in a female

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6
Q

What is the SRY gene

A

Sex determining region of the Y chromosome

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7
Q

Clinical features of Turners Syndrome

A

Female
Short stature
Webbed neck
Wide carrying angle of elbow

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8
Q

Associated medical conditions of Turners Syndrome include

A 
Coarctation of the aorta 
IBD
Sensorineural and conduction deafness 
Renal anomalies
Endocrine dysfunction - autoimmune thyroid disease
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9
Q

What patients have streak ovaries

A

Turners Syndrome

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10
Q

How does Turners Syndrome get detected

A

At birth - clinical appearance
Childhood - short stature
Adolescence - delayed puberty

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11
Q

Is pregnancy possible in Turners Syndrome

A

Yes - usually requires egg donation

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12
Q

What is XY gonadal dysgenesis

A

XY karyotype but gonads don’t develop in testis
Phenotypically Female
Genotypically Male
Pregnancy may be possible with egg donation

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13
Q

What is 46XY disorder of sex development

A

Complete androgen insensitivity syndrome.
Testes form due to SRY gene action.
Testes secrete AMH –> regression of Müllerian ducts.
Phenotypically F - F external genitalia - no uterus.
Breast development, minimal public hair.
Short vagina

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14
Q

Genital effects of congenital adrenal hyperplasia

A

Virilization of F foetus
Enlarged clitoris
Labia fused + scrotal in appearance

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15
Q

What is Mayer-Rokitansky-Kuster-Hauser syndrome

A

Müllerian agenesis - absent / rudimentary uterus + upper vagina.
Primary amenorrhea after normal pubertal development.

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16
Q

What age defines precocious puberty

A

Before 8 in F

Before 9 in M

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17
Q

2 categories of precocious puberty

A

Central (gonadotropin dependent - 75% cause unknown.)

Peripheral (always pathological)

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18
Q

Causes of central precocious puberty

A

75% unknown

25% due to CNS malformation or brain tumour

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19
Q

Causes of peripheral precocious puberty

A

Always pathological

Oestrogen secretion - e.g. Hormone producing tumour, exogenous ingestion

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20
Q

Age definition of delayed puberty

A

No secondary sexual characteristics by age 14

Due to - hypogonadotrophic hypogonadism
- hypergonadotrophic hypogonadism

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21
Q

What causes hypogonadotrophic hypogonadism

A 
Constitutional 
Anorexia nervosa
Excessive exercise 
Diabetes 
Renal failure
(Pituitary tumour, kalman's syndrome) - rare
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22
Q

What causes hypergonadotrophic hypogonadism

A

Turner syndrome
XX gonadal dysgenesis
Premature ovarian failure
Following chemo or radio therapy for child cancers.

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23
Q

What does gonadotropin releasing hormone do

A

Controls pituitary hormone secretion
GnRH secreted in a pulsatile way to stimulate LH and FSH
GnRH at constant high dose reduces LH and FSH secretion.

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24
Q

What are buserelin and goserelin

A

GnRH agonists

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25
Q

What is the effect of oestrogen on LH

A

Low oestrogen inhibits LH production.

High oestrogen increases LH production.

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26
Q

Effect of progesterone on LH and FSH

A

Low progesterone levels increase LH and FSH productions.

High progesterone levels decrease LH and FSH productions.

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27
Q

Causes of heavy menstrual bleeding

A 
Fibroids
Endometrial polyps
Coagulation disorders 
PID
thyroid disease
Drug tx - warfarin
Copper coil
Endometrial ca
Cervical ca
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28
Q

What is the new name for dysfuntional uterine bleeding

A

Bleeding of endometrial origin

Diagnosis of exclusion

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29
Q

Investigation for heavy menstrual bleeding

A 
FBC - anaemia
Coagulation screen
Pelvic USS - fibroid, endometrial polyp, cancer
Vaginal / endocervical swabs - PID
Endometrial biopsy - endometrial cancer
TFTs
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30
Q

Management of heavy menstrual bleeding

A 
Mefenamic acid (NSAID) 
Tranexamic acid 
COCP
Norethisterone - taken from day 6 to 26 
Mirena coil
GnRH agonists - short term
Endometrial ablation 
Hysterectomy
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31
Q

What is endometrial ablation / how is it done

A

Day case
Through the vagina and cervix
Hysteroscopy before + after
Full thickness of endometrium abated

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32
Q

Causes of dysmenorrhea

A 
No cause found
Endometriosis 
Adenomyosis
PID
Cervical stenosis
Haematometra
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33
Q

Diagnosis of endometriosis

A

Laparoscopy

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34
Q

Treatment of endometriosis

A

COCP (continuously is best)
Mirena
Surgical laser ablation, diathermy or excision

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35
Q

Complication of endometriosis

A

Adhesions
‘Chocolate’ ovarian cysts = endometriomas
Infertility

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36
Q

What is adenomyosis

A

Ectopic endometrial tissue within myometrium

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37
Q

Management of dysmenorrhea

A 
NSAIDS - ibruprofen, mefenamic acid
COCP
Mirena
Low fat diet
Exercise
GnRH anaologues 
Heat
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38
Q

Causes of dyspareunia

A 
PID 
Endometriosis
Ovarian cysts
STIS
Thrush / genital skin conditions (superficial dyspareunia)
Vaginal atrophy / lack of lubrication 
UTIs
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39
Q

Define primary amenorrhea

A

Failure to menstruate by age 16

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40
Q

Define secondary amenorrhea

A

Absence of menstruation for >6m that isn’t due to pregnancy, lactation or menopause

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41
Q

Causes of secondary amenorrhea

A 
Obesity
BMI <18.5
Excessive exercise 
Severe anxiety 
Pituitary tumour
Chemotherapy 
Antipsychotic drugs
Thyroid overactivity
PCOS
POI
Ashermans syndrome
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42
Q

Causes of primary amenorrhea

A 
Anatomical 
 - cervical stenosis
 - imperforate hymen
 - Müllerian agenesis
 - transverse vaginal septum
Hypothalamic-pituitary dysfunction
 - Anorexia 
 - Chronic illness 
 - excessive exercise
 - head injury
Ovarian failure
 - Turners syndrome 
 - POF
 - chemotherapy 
 - pelvic irradiation
Hypothyroidism 
Hyperthyroidism
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43
Q

Investigation of amenorrhea

A 
Pregnancy test 
Blood - LH, FSH, Testosterone 
Prolactin level
TFT
USS of ovaries 
Hysteroscopy if ashermans / cervical stenosis
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44
Q

Clinical manifestations of PCOS

A 
Menstrual irregularity - oligomenorrhoea / amenorrhea 
Hirsutism 
Subfertility
Recurrent miscarriage (50%)
Obesity
High LH 
insulin resistance 
Acanthosis nigricans
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45
Q

Diagnosis of PCOS

A

2+ of:

  • amenorrhea / oligomenorrhoea
  • hyperandrogenism
  • polycystic ovaries on USS
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46
Q

Management of PCOS

A 
COCP
Cyclical oral progesterone 
Metformin
Clomiphene
Weight reduction
Exercise
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47
Q

Management of hirsutism

A 
Eflornithine cream
Cyproterone acetate (Dianette) 
Metformin
GnRH analogues
Laser / electrolysis
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48
Q

Causes of post menopausal bleeding

A 
Atrophic vaginitis
Endometrial polyps
Endometrial hyperplasia 
Endometrial carcinoma 
Cervical carcinoma
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49
Q

Investigation of post menopausal bleeding

A

TV USS of endometrial thickness (<3mm)
Endometrial biopsy
Hysteroscopy (+curettage of polyps)

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50
Q

Management of atrophic vaginitis

A 
Topical oestrogen cream 
Oestrogen pessaries 
Oestrogen ring pessaries 
Vaginal moisturisers - daily use
Vaginal lubricants for SI
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51
Q

Management of simple or complex endometrial hyperplasia

A

Oral progesterone

Mirena

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52
Q

Management of atypical endometrial hyperplasia

A

Total abdominal hysterectomy - risk of progression to malignancy

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53
Q

Management of endometrial cancer

A

Total abdominal hysterectomy + BSO + washing +/- adjuvant therapy

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54
Q

Management of pre-menstrual syndrome

A 
Stress reduction
Exercise
Alcohol and caffeine reduction 
COCP / oestrogen patches / mirena
SSRIs
CBT
GnRH analogues 
Hysterectomy + BSO
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55
Q

Types of candida species

A 
Candida albicans
Candida tropicalis
Candida glabrata
Candida krusei
Candida parasilosis
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56
Q

Common species involved in bacterial vaginosis

A

Gardnerella vaginalis
Mycoplasma hominis
Bacteroides
Mobilincus

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57
Q

Which STI is a flagellate Protozoan

A

Trichomonas vaginalis

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58
Q

Symptoms of Trichomonas vaginalis

A

Vulval soreness + itching
Foul smelling discharge - may be frothy / green
Dysuria
Abdo discomfort
Strawberry cervix (punctate haemorrhages)

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59
Q

Diagnosis of Trichomonas vaginalis

A

Microscopy of vaginal discharge

and TV NAATs

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60
Q

Treatment of Trichomonas vaginalis

A 
Metronidazole 400mg BD for 5-7 days 
Or
Metronidazole 2 g STAT PO
OR
PV metronidazole gel (0.75%) OD 5 days 
OR
PV clindamycin cream (2%) OD  7 days 
Tx both partners
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61
Q

Symptoms of bacterial vaginosis

A

Malodorous fishy discharge
Assymptomatic carriers
More prominent during menstruation
Cream / grey discharge - commonly adheres to wall of vagina

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62
Q

What do clue cells suggest

A

Bacterial vaginosis

Clue cell = epithelial cell covered in bacteria

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63
Q

Management of bacterial vaginosis

A 
Metronidazole 400mg BD for 5-7 days 
Or
Metronidazole 2 g STAT PO
OR
PV metronidazole gel (0.75%) OD 5 days 
OR
PV clindamycin cream (2%) OD  7 days
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64
Q

Problems with bacterial vaginosis in pregnancy

A

In 1st T can –> second trimester miscarriages or preterm labour
Tx with metronidazole

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65
Q

Which STI is a gram -ve diplococcus

A

Neisseria gonorrhoea

66
Q

Symptoms of gonorrhoea

A 
Asymptomatic 
Increased vaginal discharge
Abdo / pelivic pain
Dysuria
Urethral discharge 
Proctitis / rectal bleeding 
Cervical bleeding on contact
Cervical excitation
67
Q

Causes of cervical excitation

A

Ectopic pregnancy
PID
gonorrhoea

68
Q

Treatment of gonorrhoea

A

Monotherapy - ceftriaxone 1g intramuscularly

2019 guidelines

69
Q

Which STI is an obligate intracellular pathogen

A

Chlamydia

70
Q

Symptoms / signs of chlamydia infection

A 
Asymptomatic 
Vaginal discharge 
Lower abdo pain
Intermenstrual bleeding
Cervical discharge 
Post-coital (contact) bleeding
Dysuria 
Urethral discharge
71
Q

Complications of chlamydia

A 
PID
endometritis
salpingitis
tubal infertility
Ectopic pregnancy
Fitz-Hugh-Curtis syndrome =peri-hepatitis
Neonatal or adult conjunctivitis 
Neonatal pneumonia
 conjunctivitis
Sexually acquired reactive arthritis
Epididymo-orchitis
72
Q

Treatment of chlamydia

A

First line = Doxycycline 100mg oral BD 7d (contraindicated in pregnancy)

Second line = Azithromycin 1g STAT PO, followed by 500mg OD PO 2/7

Alternative regimens:
Erythromycin 500mg BD 10–14 days
Ofloxacin 200mg BD or 400mg OD 7days

73
Q

What is PID

A

Inflammation and infection arising from endocervix
Leading to endometritis, salpingitis, oophoritis and pelvic peritonitis.
Often due to chalmydia, gonorrhoea or BV

74
Q

Symptoms / signs of PID

A 
Abdo / pelvic pain
Dyspareunia
Pyrexia >38
Heavy bleeding
Intermenstrual bleeding
Pelvic tenderness and cervical excitation on examination
Tubal damage
75
Q

Outpatient treatment of PID

A

Ceftriaxone 1g IM STAT
and doxycycline 100mg BD 14/7
and metronidazole 400mg BD 14/7

76
Q

When is hospitalisation indicated for PID

A 
Severe infection
Adnexal mass ? Abscess
Sepsis
Poor response to tx
Severe pain requiring strong analgesics
77
Q

Symptoms of herpes simplex

A 
Painful vesicles 
Ulcerations
Urine retention
May be asymptomatic 
systemic symptoms - fever + myalgia (more common with primary HSV)
78
Q

Treatment of herpes simplex

A

preferred regimens = Aciclovir 400 mg TDS for 5/7
OR Valaciclovir 500 mg BD 5/7

Alternative regimens:
Aciclovir 200 mg five x day for 5/7
Famciclovir 250 mg TDS for 5/7

79
Q

What virus causes genital warts

A

HPV 6 + 11

80
Q

Treatment of genital warts

A 
Podophyllin - BD application 3 days, followed by 4 days rest, for 4-5 cycles
Imiquimod
Cryotherapy - liquid nitrogen
Hyfrecation / excision 
(Catephen)
(TCA- specialist clinic only)
(5-Fluorouracil 5% cream - not routinely advised) 
(Interferons- expert advice)
81
Q

What causes Syphillis

A

Treponema pallidum

82
Q

Symptoms of primary syphilis

A

Painless ulcer on vulva / cervix

Englarged groin / inguinal lymph nodes

83
Q

Symptoms of secondary syphilis

A

Maculopapular rash on palms and soles

Mucous membrane ulcer

84
Q

Treatment of early syphilis

A

Benzathine penicillin G IM 2.4 MU IM single dose

85
Q

Symptoms of generalised syphilis

A

Lymphadenopathy

Arthritis

86
Q

Symptoms of neuro Syphilis

A

Meningitis
Stroke
Tabes dorsalis

87
Q

Symptoms of congenital Syphilis

A

Intrauterine death
Interstitial keratitis
VIII nerve deafness
Abnormal teeth

88
Q

Symptoms of genital TB

A

Amenorrhoea
Infertility
Acute / chronic pelvic pain
Frozen pelvis due to adhesions

89
Q

What does haemophilus ducreyi cause

A

Chancroid

90
Q

Symptoms of Chancroid

A

Painful shallow multiple ulcers

Regional lymphadenopathy + suppuration

91
Q

What causes granuloma inguinale

A

Klebsiella granulomatosis

92
Q

Typical failure rate of COCP per 100 women years

A

9 %

93
Q

Typical Failure rate of POP per 100 women years

A

9%

94
Q

Failure rate of mirena per 100 women years

A

0.5%

95
Q

Failure rate of depo prova per 100 women years

A

0.1-2%

96
Q

Typical Failure rate of condom per 100 women years

A

17-21%

97
Q

Mechanism of action of COCP

A

Inhibition of ovulation
Atrophic endometrium
Thickened cervical mucus

98
Q

Absolute CI to COCP use

A

0 to <6 weeks postpartum + breastfeeding
0 to <3 weeks postpartum + other VTE risk
Age ≥35 years + 15 cigarettes / day
Hypertension ≥160 / 100
Vascular disease / impaired cardiac function
Hx of DVT / PE / stroke / IHD
Major surgery with prolonged immobilisation
Migraine with aura
Current breast cancer
Viral hepatitis / decompensated cirrhosis / liver tumours
Thrombogenic mutations / Positive antiphospholipid antibodies

99
Q

SE of COCP

A 
altered mood - no causal relationship with depression
Mood swings
Headache 
Loss of libido
Nausea
percieved weight gain - no causal relationship
Bloatedness
Breakthrough bleeding
Vaginal discharge 
Breast pain
100
Q

Benefits of COCP

A 
Lighter less painful periods 
Regular bleeds
Improved pre-menstrual syndrome
Reduced risk of PID
Protect against ovarian and endometrial cancer
101
Q

Mechanism of action of progesterone methods

A

Thickened cervical mucus

Thin endometrium

102
Q

Common SE of progesterone only methods

A

Irregular / absent menstrual bleeding
Simple ovarian cysts
Breast tenderness
Acne

103
Q

Risk of depo provera

A

Loss of bone mineral density
Weight gain (2-3kg in 1st yr)
Delay in return of fertility
Irregular / absent menstruation

104
Q

Mechanism of action of copper IUD

A

Toxic to egg and sperm

105
Q

SE of copper IUD

A

Heavier periods
Increased menstrual pain
Increased spotting

106
Q

Duration of action of depo, implant, mirena, copper coil

A

Depo = 12 weeks
Implant = 3 years
Mirena = 5 years
Copper coil = 10 years

107
Q

CI to intrauterine contraception

A 
Current STI
PID
malignant trophoblastic disease
Unexplained vaginal bleeding
Endometrial cancer
Cervical cancer
Malformation of uterus 
Copper allergy
108
Q

Techniques to calculate the fertile period

A

Change in basal body temp
Change in cervical mucus
Track cycle days
Combination of above

109
Q

Types of emergency contraception

A

Levonelle
EllaOne
Copper IUD

110
Q

Early medical termination - drugs used + gestation

A

Mifepristone oral + misoprostal

4 - 9weeks

111
Q

Later medical termination - drugs used + gestation

A

Mifepristone oral + misoprostal pessary every 3-6 hours
+ analgesia
12 - 24weeks

112
Q

surgical termination - technique used + gestation

A

Suction 4-6 weeks
Suction under GA 6-14 weeks
Dilation and evacuation 12-24weeks

113
Q

Possible Complications of termination

A 
Incomplete abortion 
Endometritis and resultant tubal damage
Uterine perforation 
cervical trauma
Psychological SE
114
Q

Factors decreasing fertility

A 
Increasing age
Smoking
Less frequent sex
Alcohol
Obesity
NSAIDs
Chemotherapy
115
Q

Presentation of ectopic pregnancy

A 
\+ve pregnancy test
Abdo / adnexal pain
Vaginal bleeding
Cervical excitation
fainting
116
Q

Investigation of ectopic pregnancy

A 
obs - BP, HR, RR, temp
Hb
Group + save
Beta-HCG
TVUSS
117
Q

Management of ectopic pregnancy

A

IM methotrexate

laparoscopy - salpingectomy / salpingotomy

118
Q

Define threatened miscarriage

A

Vaginal bleeding

Os closed

119
Q

Define inevitable miscarriage

A

Vaginal bleeding

Os open

120
Q

Define incomplete miscarriage

A

Vaginal bleeding

Os open, products of conception in os

121
Q

Define complete miscarriage

A

Pain and bleeding resolved
os closed
No retained products on USS

122
Q

Define missed miscarriage

A

Fetal pole present on USS - no heart beat
Or Gestational sac present but no fetal pole

No pain or bleeding

123
Q

Management of miscarriage

A

Expectant
Medical - misoprostal
Surgical - SMOM

124
Q

Define cervical ectropion

A

Benign condition
Columnar epithelium on vaginal aspect of cervix.
Transforms to squamous epithelium

125
Q

Define nabothian follicle

A

Mucus filled cyst within the ectocervix - not significant - no tx needed

126
Q

Causes of cervical ectropion

A

Puberty
Pill
Pregnancy

127
Q

Causes of cervical stenosis

A

Usually iatrogenic
Cervical cone biopsy / LLETZ
Endometrial ablation devices

128
Q

What is asherman’s syndrome

A

Endometrial cavity fibrosis and adhesion

129
Q

What is a uterine fibroid

A

Benign tumour of uterine smooth muscle = leiomyoma

130
Q

Risk factors for uterine fibroids

A

Nulliparity
Obesity
Family history
African origin

131
Q

Symptoms of uterine fibroids

A

Pelvic mass
Menstrual disturbance
Pressure symptoms - urinary frequency

132
Q

Management of fibroids

A 
Conservative
Medical tx for heavy menstrual bleeding
Uterine artery embolisation
Myomectomy
Hysterectomy
133
Q

Cell types of endo and ecto cervix

A 
Endocervix = canal = columnar glandular epithelium
Ectocervix = external = squamous epithelium
134
Q

Symptoms and causes of acute cervicitis

A 
Irritation, mucus/pus discharge 
Dyspaerunia
Post coital bleeding
Inter-menstrual bleeding
STIs
135
Q

Cell type of cervical polyp

A

Endocervical = columnar (glandular) epithelium

136
Q

symptoms of cervical polyp

A

Asymptomatic
Intermenstrual bleeding
Post coital bleeding
Rarely >1cm

137
Q

What is cervical dysplasia

A

Cervical intraepithelial neoplasia.

Atypical cells in the squamous epithelium

138
Q

If untreated what % of CIN develop cancer over 10 years

A

1/3 with CIN II or III

CIN Commonly regresses - can progress to CIN II or III

139
Q

What age is CIN most common

A

90% <45yo

Peak incidence 25-29

140
Q

Aetiology of cervical cancers

A

HPV 16, 18, 31, and 33 most common.
HPV vaccine is for 16 and 18
Oral contraceptives (all COC, POP, depot)
Smoking

141
Q

Biggest risk factor for the development of cervical cancer

A

Non-attendance for cervical screening

142
Q

Who is invited for cervical screening + how often

A

25-64
Every 3 years until 50 then 5 yearly until 65.
Annually if HOV +ve

143
Q

Describe colposcopy

A

Speculum ex + microscope magnification 10-20x
Acetic acid stain + iodine
+ biopsy

144
Q

What is a LLETZ procedure + what’s it for

A

Large loop excision of the transformation zone

For CIN II or III

145
Q

Possible complications of LLETZ

A

Haemorrhage
Cervical stenosis
Slight increased risk of preterm delivery

146
Q

Peak incidence of cervical carcinoma

A

2 peaks -30s and 80s

147
Q

Types of cervical carcinoma

A

90% squamous malignancies

10% adenocarcinomas (worse prognosis)

148
Q

What organism causes chancroid

A

Hawmophilus ducreyi

149
Q

Presentation of chancroid (STI)

A

Ulcerative
Small papule, ulcerates
Forms a single or multiple painful superficial ulcers
Inflammation can lead to phimosis
Enlargement and suppuration of inguinal LN may occur –> bubo formation

150
Q

Features of acute PID

A

Pelvic pain
Pyrexia
Cervical excitation
Adnexal tenderness

151
Q

Presentation of bacterial vaginosis

A

Creamy-grey discharge
Fishy odour
No itch

152
Q

What do clue cells on microscopy indicate

A

Bacterial vaginosis

153
Q

What is Stress incontinence

A

Involuntary leakage of urine on effort / exertion /sneezing / coughing.
Due to an incompetent sphincter.
May be associated with genitourinary prolapse.

154
Q

What is Urge incontinence

A

Involuntary urine leakage
Accompanied by/ immediately preceded by urgency.
Due to detrusor instability or hyperreflexia leading to involuntary detrusor contraction.

155
Q

What is Mixed incontinence

A

Involuntary leakage of urine associated with urgency and exertion/effort/sneezing/ coughing.

156
Q

What is Overactive bladder syndrome (OAB)

A

Urgency with or without urge incontinence
+ usually frequency and nocturia.
+/- Incontinence

157
Q

What is Overflow incontinence

A

Due to chronic bladder outflow obstruction.
Often due to prostate disease in M.
Can be due to a neurogenic bladder.

158
Q

What is True incontinence

A

continuous urine leakage

May be due to a ureto/urethro/bladder-vaginal fistula

159
Q

Treatment of PCOS

A

COCP

Metformin

160
Q

What is tranexamic acid

A

Anti-fibrinolytic

161
Q

Cause of a single painless ulcer on genital area

A

Primary Syphilis

162
Q

Multiple painless maculopapular ulcers with lymphadenopathy following a primary genital answer is due to what

A

Secondary syphilis

General Medicine (25 decks)

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